After Paul Carter died at the Imperial of Hazel Crest Nursing Home in Illinois, his widow sued both the facility and the doctor in charge of his care. She claimed that after her husband was discharged from a hospital stay back to the nursing home, his physician failed to prescribe the insulin that Mr. Carter, a diabetic, needed to survive. She settled her lawsuit against the nursing home for $125,000; a jury awarded her $1.3 million against the attending physician.

In a sad irony, Mr. Carter was first admitted to Imperial precisely because his wife believed that it provided better care to bedridden patients than the nursing home and hospital where he had been treated. On his first admission his care was taken over by Dr. Abdol Azaran, the medical director at Imperial.

Mr. Carter had been a diabetic for over forty years, requiring daily injections of insulin. Dr. Azaran entered an order to continue daily insulin; because of Mr. Carter’s dementia, he was unable to participate in that or other treatment decisions.

A few days after his initial admission to Imperial, Mr. Carter was hospitalized for a urinary tract infection. During that stay Dr. Azaran ordered that his daily insulin shots be supplemented with periodic blood glucose checks and, when necessary, injections of a faster-acting insulin.

By the time Mr. Carter was returned to Imperial his daily insulin shots had been abandoned in favor of the regular glucose monitoring. In the course of the readmission, however, Dr. Azaran’s order for fast-acting insulin also got cancelled, so that Mr. Carter received no insulin whatsoever. He also had decubitis ulcers on his tailbone and heel, and he refused to (or could not) eat. Mrs. Carter discovered that the insulin had been stopped when she inquired about his condition.

Dr. Azaran did not return at least three attempts to page him for instructions on Mr. Carter’s care, and he was finally re-hospitalized at the direction of Imperial’s Nursing Director. Doctors at the hospital found that he had suffered a mild heart attack, and treated him for decubitis ulcers, dehydration, pneumonia and infection of both his bladder and his decubitis ulcers. Mr. Carter was discharged back to Imperial a month later, and lived another three months at the facility.

The jury awarded $55,000 for actual medical expenses, $385,000 for aggravation of existing medical conditions and $1,060,000 for pain and suffering against Dr. Azaran, and he appealed. The Illinois Court of Appeals upheld the judgment; the evidence supported the jury’s award and it did not “exceed the limits of fair and reasonable compensation.” Dr. Azaran’s novel argument that Mr. Carter “would have paid for a bed to sleep in at the nursing home” did not mean his estate could not recover all the costs of medical care. Carter v. Azaran, July 22, 2002.